EDITORIAL - Volume 14, Issue 3 - October 2012

Following our well-received Summer theme issue on cognition, guest edited by Drs. Ralph Benedict and Kathleen Fuchs, this issue of the IJMSC returns to our usual broad range of articles on comprehensive multiple sclerosis (MS) care. Our major sponsoring organization, the Consortium of Multiple Sclerosis Centers (CMSC)—in addition to holding a popular annual meeting after Memorial Day each year as well as various continuing education activities throughout the year to educate health-care professionals about MS—arranges periodic consensus conferences on a variety of topics. These conferences provide an opportunity for diverse professionals to come together for both formal presentations and discussions on a topic of interest to the MS health-care community, and their goal is usually to develop a consensus statement or guidelines of use to that community. The Summer issue of the IJMSC led off with a consensus statement on neuropsychological testing in MS. The current issue opens with a report on a consensus conference on the use of magnetic resonance imaging (MRI) in the classification of MS that was organized by Dr. Stuart Cook of the University of Medicine and Dentistry of New Jersey. The international group of experts consisting of clinicians (both neurologists and nurse practitioners), neuropathologists, radiologists, and biostatisticians evaluated the desirability of using contrast-enhancing lesions in the classification of MS. The participants recommended that evidence of new MRI contrast-enhancing lesions and unequivocal T2 hyperintense lesions (ie, evidence of subclinical disease activity) be added to the clinical classification of MS to help distinguish relapsing inflammatory from progressive forms of MS.

Two of the remaining six articles in the current issue consider aspects of different types of exercise in MS, namely walking and aquatic therapy. Dr. Karpatkin of Hunter College in Brooklyn, New York, and Dr. Rzetelny of Southern Illinois University at Carbondale presented their research on walking and perceptions of fatigue at a recent CMSC meeting to great interest, and now discuss it for a broader audience. People with MS often complain of difficulty with ambulation, yet walking is an especially accessible potential form of exercise. The authors found that walking in an intermittent rather than a continuous manner can conserve energy while improving overall function. Ms. Brown and colleagues of the University of Manitoba in Winnipeg, Canada, examined another frequently recommended type of exercise for MS patients: aquatic therapy. They looked specifically at ways to increase use of this form of exercise by studying barriers and facilitators related to participation in aquafitness programs by MS patients.

In the last few years, there has been increasing emphasis on overall wellness in MS patients and concern that many patients are not participating in basic preventive screening. Dr. Paraska of Duquesne University in Pittsburgh examined one aspect of this problem, namely breast cancer screening by mammography, which is particularly relevant given the current 4:1 ratio of females to males with MS (although men can also suffer from breast cancer, this article examines only women's attitudes toward screening). Given the aging population, various types of preventive health screening will be increasingly needed, and this study helps us understand how to improve overall care for our patients.

Two other articles discuss various aspects of support for MS patients so they don't have to “go it alone”; such support can come from both a team of MS clinical professionals and from other people in MS patients' lives who serve as confidants. Dr. Falk-Kessler of Columbia University in New York and colleagues investigated the role of the occupational therapist in increasing the resilience of individuals with MS. Dr. Grose and colleagues of Plymouth University in the United Kingdom operate in a very different health-care system but examined similar issues, exploring the need for psychosocial support of individuals with MS not only by members of the health-care team but also by family members and friends, especially the patient's closest confidant.

Rounding out this already full issue is a discussion of the role of nurses in the assessment and treatment of a very challenging aspect of the MS disease process: the relapse. Ms. Perrin Ross of Loyola University Chicago and colleagues provide a consensus statement from a working group of nurses who convened to discuss the two specific topics of assessing patients when they present with symptoms of a relapse, and evaluating outcomes of acute management. The group designed a questionnaire that can be administered by clinicians or patients themselves and is currently being piloted in several practice settings.

We hope that the current issue is useful to you as you care for your MS patients. We also invite you to explore our new website, IJMSC.org, which now has a searchable archive of all issues going back to 2004. While the website can be easily accessed on tablet computers, there is also a mobile-optimized site for readers who like to keep moving at all times. Please let us know what you think of the new site, and whether you have any questions about its use.

Happy Fall!